Progression Inhibitor For Disease Attributed To Abnormal Accumulation Of Liver Fat

ABSTRACT

The present invention provides pharmaceutical compositions useful as agents for the inhibition of progression of diseases associated with abnormal accumulation of liver lipids. In particular, the pharmaceutical compositions of the present invention which comprise as an active ingredient a sodium/glucose co-transporter 2 inhibitor are highly suitable as an agent for the inhibition of progression of not only common fatty liver but also non-alcholic fatty liver disease (NAFL), non-alcholic steatohepatitis (NASH), hypernutritive fatty liver, diabetic fatty liver, alcholic fatty liver disease toxic fatty liver or the like.

TECHNICAL FIELD

The present invention relates to an agent for the inhibition ofprogression of diseases associated with abnormal accumulation of liverlipids, which comprises as an active ingredient a sodium/glucoseco-transporter 2 (hereinafter referred to as SGLT2).

BACKGROUND ART

The patients with disorders in which lipids are abnormally accumulatedin liver, such as non-alcoholic steatohepatitis (NASH), hypernutritivefatty liver, diabetic fatty liver, alcoholic fatty liver, and toxicfatty liver as well as common fatty liver are increasing year by year.Above all, non-alcoholic steatohepatitis (NASH) is particularlyacknowledged as a problem, because it exhibits serious symptoms (seenon-Patent Reference 1 or 2). Moreover, it has been pointed out thatabnormal lipid accumulation in liver causes liver inflammation or fibrilformation in liver (liver cirrhosis) and makes shifts to seriousdisorders such as liver cancer (see non-Patent References 1 to 4), andthus, inhibiting this lipid accumulation is extremely important.

It is believed that various factors including recent lifestyle changesoverlap each other and abnormalities in liver energy metabolism arecaused and as a consequence, lipid accumulation in liver occurs.Therefore therapeutic modality is not uniform (see non-Patent Reference5). Although presently, dietary therapy, exercise therapy,pharmacotherapy and the like are tried as remedies for lipidaccumulation in liver, these modalities have difficulties in control orcontinuing implementation. Therefore, therapeutic effects are not alwayssatisfied. Meanwhile, in pharmacotherapy, polyene-phosphatidyl cholinepreparation is only listed under coverage. As described above, satisfiedtreatment modality for lipid accumulation in liver has not beenestablished, and thus development of more effective drug for lipidaccumulation has been desired.

It is known that SGLT2 inhibitors are drugs which exhibit bloodglucose-lowering action by inhibiting sugar reabsorption in kidney, andare useful as drugs for the prevention or treatment of diabetes mellitus(for example, see Patent References 1 to 19). In addition, as to SGLT2inhibitor, it has been also proposed that concurrent use of T1095represented by formula:

and a peroxisome proliferator-activated receptor (hereinafter referredto as PPAR) agonist or a retinoid X receptor (hereinafter referred to asRXR) agonist can suppress the onset of side effects such as fatty livercaused by PPAR agonists or RXR agonists, and therefore the dosage ofPPAR agonist or RXR agonist can be reduced (see Patent Reference 20 or21). However, it has not ever been known that SGLT2 inhibitors exhibitsuppressive effects on abnormal accumulation of liver lipids asdescribed in the present invention.

In the treatment of diabetic fatty liver, use of hypoglycemic agents hasbeen studied (see non-Patent Reference 6). However, usefulness ofdiabetic drugs with blood glucose-lowering actions has been notconfirmed, for example, it has been pointed out that tolbutamide doesnot exhibit suppressive effects on lipid accumulation in liver (seenon-Patent Reference 7), and may adversely cause exacerbation of lipidaccumulation in liver (see non-Patent Reference 6).

In addition, it has been reported that clofibrate of anantihyperlipidemic agent causes lipid accumulation in liver as a sideeffect, while it lowers neutral fat or cholesterol in blood (see PatentReference 22). Furthermore, it has been reported that microsomaltriglyceride transfer protein (hereinafter referred to as MTP) inhibitorof an antihyperlipidemic agent causes lipid accumulation in liver, whileit lowers neutral fat or cholesterol blood (See Patent References 23 and24 and non-Patent References 8 and 9). As described above, in use ofthese antihyperlipidemic drugs, no correlation is observed in the amountof neutral fat or cholesterol between in blood and in liver, butinduction of fatty liver is observed in some cases.

Patent Reference 1: International Publication WO02/28872 pamphlet;

Patent Reference 2: International Publication WO02/44192 pamphlet;

Patent Reference 3: International Publication WO02/53573 pamphlet;

Patent Reference 4: International Publication WO01/16147 pamphlet;

Patent Reference 5: International Publication WO01/68660 pamphlet;

Patent Reference 6: International Publication WO03/11880 pamphlet;

Patent Reference 7: International Publication WO03/00712 pamphlet;

Patent Reference 8: International Publication WO02/068440 pamphlet;

Patent Reference 9: International Publication WO02/68439 pamphlet;

Patent Reference 10: International Publication WO02/64606 pamphlet;

Patent Reference 11: International Publication WO03/80635 pamphlet;

Patent Reference 12: International Publication WO02/88157 pamphlet;

Patent Reference 13: International Publication WO02/36602 pamphlet;

Patent Reference 14: International Publication WO03/20737 pamphlet;

Patent Reference 15: International Publication WO01/74835 pamphlet;

Patent Reference 16: International Publication WO01/74834 pamphlet;

Patent Reference 17: Japanese Patent Publication 2003-012686;

Patent Reference 18: International Publication WO01/27128 pamphlet;

Patent Reference 19: International Publication WO03/99836 pamphlet;

Patent Reference 20: International Publication WO02/080936 pamphlet;

Patent Reference 21: International Publication WO02/080935 pamphlet;

Patent Reference 22: Japanese Patent Publication H8-119860;

Patent Reference 23: Japanese Patent Publication 2002-220345;

Patent Reference 24: International Publication WO03/075232 pamphlet;

Non-patent Reference 1: Hiromasa Ishii IGAKU NO AYUMI (Journal ofClinical and Experimental Medicines, 2003, Vol. 206, No. 5, pp. 323-325;

Non-patent Reference 2: Naoki Tanaka and one person, KANZO (ActaHepatologica Japonica), 2002, Vol. 43, No. 12, pp. 539-549;

Non-patent Reference 3: Kazuhiko Koike, IGAKU NO AYUMI (Journal ofClinical and Experimental Medicine), Vol. 206, No. 5, pp. 385-388;

Non-patent Reference 4: Koutaro Uchimura and three persons, RINSHO TOKENKYU (The Japanese Journal of Clinical and Experimental Medicine),2003, Vol. 80, No. 3, pp. 503-506;

Non-patent Reference 5: Kenichiro Iwamura, KANZO (Acta HepatologicaJaponica), 1971, Vol. 12, No. 12, pp. 659-669;

Non-patent Reference 6: Kenichiro Iwamura, SAISIN-IGAKU (The MedicalFrontline), 1979, Vol. 33, No 3, pp. 524-531;

Non-Patent Reference 7: A. Beringer and three persons, DeutscheMedizinische Wochenschrift, 1967, vol. 92, No., pp. 2388-2392;

Non-patent Reference 8: Ken Ohashi, Annual review. NAIBUNPI, TAISHA 2000(Internal Secretion, Metabolism 2000), Chugaiigaku Co. publication, pp.17-23;

Non-Patent Reference 9: JunichiOsuga, NAIKA (Internal Medicine), 2002,vol. 89 No. 5, pp. 875-881.

DISCLOSURE OF THE INVENTION Problem to be Solved by the Invention

The object of the present invention is to provide useful pharmaceuticalcompositions for the inhibition of progression of the diseasesassociated with abnormal accumulation of liver lipids.

Means of Solving the Problems

In view of the above object, the present inventors have studiedearnestly to find a compound having an effect to inhibit lipidaccumulation in liver, and they acquired the surprising knowledge thatSGLT2 inhibitor had an excellent effect inhibiting lipid accumulation,thereby forming the bases of the present

That is, the present invention relates to:

1 a pharmaceutical composition for the inhibition of progression of adisease associated with abnormal accumulation of liver lipids, whichcomprises as an active ingredient a SGLT2 inhibitor;

[2] a pharmaceutical composition as described in the above 1 wherein theSGLT2 inhibitor is 2-(4-methoxybenzyl)-phenyl β-D-glucopyranoside or apharmaceutically acceptable salt thereof, or a prodrug thereof;

[3 a pharmaceutical composition as described in the above 1] or [2]which is used in combination with one or more selected from a groupconsisting of metformin, troglitazone, pioglitazone hydrochloride,bezafibrate and voglibose; and the like.

The term “SGLT2 inhibitor” as an active ingredient of the presentinvention means a compound inhibiting sugar reabsorption in kidney byinhibiting SGLT2 activity. As the SGLT2 inhibitor of the presentinvention, SGLT2 inhibitors described in the above Patent References 1to 19 can be illustrated, and concrete examples of desirable executionmode include compounds selected from the following group andpharmaceutically acceptable salts thereof.

2-(4-Methoxybenzyl)phenyl β-D-glucopyranoside, 2-(4-methylbenzyl)phenylβ-D-glucopyranoside, 2-(4-ethyl-benzyl)phenyl-D-glucopyranoside,2-(4-isobutylbenzyl)-phenyl β-D-glucopyranoside,2-(4-ethoxybenzyl)phenyl β-D-glucopyranoside,2-(4-isopropoxybenzyl)phenyl β-D-glucopyranoside,5-hydroxymethyl-2-(4-propoxybenzyl)-phenyl β-D-glucopyranoside,2-(4-ethylbenzyl)-5-hydroxy-methylphenyl β-D-glucopyranoside,2-[4-(2-hydroxyethyl)-benzyl]-5-hydroxymethylphenyl β-D-glucopyranoside,2-[4-(2-hydroxyethyl)benzyl]phenyl β-D-glucopyranoside, 2-[4(3-hydroxypropyl)benzyl]phenyl β-D-glucopyranoside,2-(4-ethylthiobenzyl) phenyl β-D-glucopyranoside,2-(4-methoxybenzyl)phenyl 6-O-ethoxycarbonyl-β-D-gluco-pyranoside,2-(4-methoxybenzyl)phenyl 6-O-methoxy-carbonyl-β-D-glucopyranoside,2-(4-methoxybenzyl)phenyl-6-O-[2-(methoxy)ethyloxycarbonyl]-β-D-glucopyranoside,2-(4-methoxybenzyl phenyl 6-O-hexanoyl-β-D-glucopyranoside,2-(4-methoxybenzyl)phenyl 6-O-propionyl-β-D-glucopyranoside,2-(4-methoxybenzyl)phenyl 6-C-butyryl-β-D-glucopyranoside,2-(4-methoxybenzyl)phenyl 6-o-acetyl-β-D-glucopyranoside,2-(4-methoxybenzyl)phenyl 6-O-isobutyryl β-D-glucopyranoside,2-(4-methoxybenzyl)phenyl 6-O-ethylsuccinyl-β-D-gluco-pyranoside,2-(4-methoxybenzyl)phenyl 6-O-isopropyloxy-carbonyl-β-D-glucopyranoside,2-(4-methylbenzyl)phenyl-6-O-ethoxycarbonyl-β-D-glucopyranoside,2-(4-methylbenzyl)-phenyl 6-O-methoxycarbonyl-β-D glucopyranoside,2-(4-ethylbenzyl)phenyl 6-O-ethoxycarbonyl-β-D-glucopyranoside,2-(4-ethylbenzyl)phenyl 6-O-methoxycarbonyl-β-D-gluco-pyranoside,5-amino-2-(4-ethylbenzyl)phenyl β-D-gluco-pyranoside,2-[4-(3-hydroxypropyl)benzyl]-3,5-dimethyl-phenyl β-D-glucopyranoside,2-[4-(2-hydroxyethyl)benzyl]-3,5-dimethylphenyl β-D-glucopyranoside,2-(4-methoxybenzyl-3,5-dimethylphenyl-D-glucopyranoside,2-(4-ethylbenzyl)-5-hydroxymethylphenyl6-O-ethoxycarbonyl-β-D-glucopyranoside,2-(4-ethylbenzyl)-5-pivaloyloxymethylphenylβ-D-gluco-6-O-butyryl-β-D-glucopyranoside, 5-acetoxy-2-(4-ethyl-benzyl)phenyl 6-O-acetyl-β-D-glucopyranoside,2-(4-ethylbenzyl)-5-(ethoxycarbonyloxymethyl) phenylβ-D-gluco-pyranoside, 2-(4-ethylbenzyl)-5-hydroxymethylphenyl6-O-hexanoyl-β-D-glucopyranoside,2-(4-ethylbenzyl)-5-hydroxy-methylphenyl6-O-pivaloyl-β-D-glucopyranoside2-(4-ethyl-benzyl)-5-hydroxymethylphenyl-O-isobutyloxycarbonyl-β-D-glucopyranoside,2-(4-ethylbenzyl)-5-hydroxymethylphenyl-O-isopropyloxycarbonyl-β-D-glucopyranoside,2-[4-(2-benzyl-oxyethyl)benzyl]phenyl6-O-ethoxycarbonyl-β-D-gluco-pyranoside,2-[4-(2-benzyloxyethyl)benzyl]phenyl 6-O-acetyl-β-D-glucopyranoside,2-[4-(2-acetoxyethyl)benzyl]phenyl 6-O-acetyl-β-D-glucopyranoside,2-(4-pyrazole-1-ylbenzyl)-phenyl β-D-glucopyranoside,2-[4-(4-hydroxypiperidin-1-yl-benzyl]3-D-glucopyranoside,3-(β-D-glucopyranosyloxy)-4-[(4-isopropoxyphenyl)methyl]-5-methyl-1H-pyrazole,3-(β-D-glucopyranosyloxy)-5-methyl-4-[(4-propylphenyl)methyl]-1H-pyrazole,3-(β-D-glucopyranosyloxy)-4-[(4-isobutylphenyl)-methyl]-5-methyl-1H-pyrazole,3-(β-D-glucopyranosyloxy)-5-methyl-4-[(4-propoxyphenyl)methyl]-1H-pyrazole,4-[(4-ethoxyphenyl)methyl]-3-(β-D-glucopyranosyloxy)-5-methyl-1H-pyrazole,3-(β-D-glucopyranosyloxy)-5-methyl-4-[(4-methyl-thiophenyl)methyl]-1H-pyrazole,5-ethyl-3-(β-D-gluco-pyranosyloxy)-4-[(4-methylthiophenyl)methyl]-1H-pyrazole,3-(β-D-glucopyranosyloxy)-4-[(4-isopropylphenyl)methyl]-5-methyl-1H-pyrazole,3-(β-D-glucopyranosyloxy)-4-[(4-methyl-thiophenyl)methyl]-5-trifluoromethyl-1H-pyrazole,3-(β-D-glucopyranosyloxy)-4-[4-methoxyphenyl)methyl]-5-trifluoro-methyl-1H-pyrazole,3-(β-D-glucopyranosyloxy)-4-[(4-methoxyphenyl)methyl]-5-methyl-1H-pyrazole,3-(β-D-gluco-pyranosyloxy)-1-methyl-4-[(4-methylthiophenyl)methyl]-5-trifluoromethylpyrazole,3-(β-D-glucopyranosyloxy)-5-methyl-4-[(4-methylphenyl)methyl]-1H-pyrazole,4-[(4-ethyl-phenyl)methyl]-3-(β-D-glucopyranosyloxy)-5-methyl-1H-pyrazole,4-[(4-ethylphenyl)methyl]-3-(β-D-glucopyranosyl-oxy)-5-trifluoromethyl-1H-pyrazole,3-(1-D-glucopyranosyl-oxy)-4-[(4-methoxyphenyl)methyl]-1,5-dimethylpyrazole,3-(β-D-glucopyranosyloxy)-1-methyl-[(4(4-methylthiophenyl)-methyl]-5-trifluoromethylpyrazole,1-ethyl-3-(β-D-gluco-pyranosyloxy)-4-[(4-methylthiophenyl)methyl]-5-trifluoro-methylpyrazole,3-(β-D)-glucopyranosyloxy)-4-[(4-methyl-thiophenyl)methyl]1-propyl-5-trifluoromethylpyrazole,3-(β-D-glucopyranosyloxy)-4-[(4-isopropoxyphenyl)methyl]-5-methyl-1-propylpyrazole,1-ethyl-3-(β-D-glucopyranosyl-oxy)-4-[(4-isopropoxyphenyl)methyl]-5-methylpyrazole,1-ethyl-3-(β-D-glucopyranosyloxy)-4-[(4-methoxyphenyl)-methyl]-5-methylpyrazole,3-(β-D-glucopyranosyloxy)-4-[(4-methoxyphenyl)methyl]-5-methyl-1-propylpyrazole,1-ethyl-4-[(4-ethoxyphenyl)methyl]-3-(β-D-glucopyranosyl-oxy)-5-methyl-1-propylpyrazole,1-ethyl-4-[(4-ethylphenyl)-methyl]-3-(β-D-glucopyranosyloxy)-5-methylpyrazole,4-[(4-ethylphenyl)methyl]-3-(β-D-glucopyranosyloxy)-5-methyl-1-propylpyrazole,3-(β-D-glucopyranosyloxy)-4-[(4-isopropoxy-phenyl)methyl]1-isopropyl-5-methylpyrazole,3-(β-D-gluco-pyranosyloxy)-5-methyl-4-([4-(cyclopropylidenemethyl)-phenyl]methyl)-1H-pyrazole,3-(β-D-glucopyranosyloxy)-5-methyl-4-[(4-cyclopropylphenyl)methyl]-1H-pyrazole,(E)-4-{[4-(buta-1-en-1-yl)phenyl]methyl}-3-(β-D-glucopyranosyl-oxy)-5-methyl-1H-pyrazole,3-(β-D-glucopyranosyloxy)-5-methyl-4-{[4-thiazole-2-yl)phenyl]methyl}-1H-pyrazole,3-(β-D-glucopyranosyloxy)-4-{[4-(3-hydroxypropyl)phenyl]-methyl}-5-trifluoromethyl-1H-pyrazole,3-(β-D-gluco-pyranosyloxy)-5-methyl-4-{[4-(2-methylpropa-1-en-1-yl)-phenyl]methyl}-1H-pyrazole,4-[4-(4-fluorophenyl)phenyl]-methyl}-3-(β-D-glucopyranosyloxy)-5-methyl-1H-pyrazole,4-{[4-(cyclobutyloxy)phenyl]methyl}-3-(β-D-glucopyranosyl-oxy)-5-methyl-H-pyrazole,3-(β-D-glucopyranosyloxy)-5-methyl-1-(cyclopropylmethyl)-4-[(4-cyclopropylphenyl)-methyl]-1H-pyrazole,1-(cyclopropylmethyl)-3-(β-D-gluco-pyranosyloxy)-5-methyl-4-[(4-methylthiophenyl)methyl]-1H-1-pyrazole,4-[(4-ethylphenyl)methyl]-3-(β-D-glucopyranosyl-oxy)-1-(3-hydroxypropyl)-5-methyl-1H-pyrazole,2-(4-pyrazole-1-ylbenzyl) β-D-glucopyranoside,2-(4-[(4-hydroxy-piperidin-1-yl)benzyl]phenyl β-D-glucopyranoside,4-[(4-isopropoxyphenyl)methyl]-1-isopropyl-3-(β-O-methoxycarbony-β-D-glucopyranosyloxy)-5-methylpyrazole,3-(6-O-ethoxy-carbonyl-β-D-glucopyranosyloxy)-4-[(4-isopropoxyphenyl)-methyl]-1-isopropyl-5-methylpyrazole,3-(6-O-isopropoxy-carbonyl-β-D-glucopyranosyloxy)-4-[(4-isopropoxyphenyl)-methyl]-1-isopropyl-5-methylpyrazole,3-(6-O-isobutoxy-carbonyl-β-D-glucopyranosyloxy)-4-[(4-isopropoxyphenyl)-methyl]-1-isopropyl-5-methylpyrazole,4-[(4-ethylphenyl)-methyl]-1-isopropyl-3-(6-O-methoxycarbonyl-β-D-glucopyranosyloxy)-5-methylpyrazole,3-(6-O-ethoxycarbonyl-β-D-gluco-pyranosyloxy)-4-[(4-ethylphenyl)methyl]-1-isopropyl-5-methylpyrazole,4-[(4-ethylphenyl)methyl]-3-(6-O-iso-propoxycarbonyl-β-D-glucopyranosyloxy)-1-isopropyl-5-methylpyrazole,4-[(4-ethylphenyl)methyl]-3-(6-O-isobutoxy-carbonyl-β-D-glucopyranosyloxy)-1-isopropyl-5-methyl-pyrazole,4-L(4-ethloxyphenyl)methyl-1-isopropyl-5-methyl-methoxycarbonyl-β-D-glucopyranosyloxy)-5-methylpyrazole,3-(6-O-ethoxycarbonyl-β-D-glucopyranosyloxy)-4-[4-ethoxy-phenyl)methyl]-1-isopropyl-5-methylpyrazole,4-[(4-ethoxy-phenyl)methyl]-3-(6-O-isopropoxycarbonyl-β-D-gluco-pyranosyloxy)-1-isopropyl-5-methylpyrazole,3-(6-O-ethoxycarbonyl-β-D-glucopyranosyloxy)-1-isopropyl-4-[(4-methoxyphenyl)methyl]-5-methylpyrazole,4-[(4-ethoxyphenyl)-methyl]-3-(6-O-isobutoxycarbonyl-β-D-glucopyranosyloxy)-1-isopropyl-5-methylpyrazole,1-isopropyl-3-(6-O-methoxy-carbonyl-β-D-glucopyranosyloxy)-4-[(4-methoxyphenyl)-methyl]-5-methylpyrazole,3-(6-O-isopropoxycarbonyl-D-D-glucopyranosyloxy)-1-isopropyl-4-[(4-methoxyphenyl)-methyl]-5-methylpyrazole,3-(6-O-isopropoxycarbonyl-β-D-glucopyranosyloxy)-1-isopropyl-4-[(4-methoxyphenyl)-methyl]-5-methylpyrazole,2-[(4-ethoxyphenyl)methyl]-4-(β-D-glucopyranosyl)-1-chlorobenzene,1-isopropyl-3-(6-D-methoxycarbonyl-β-D-glucopyranosyloxy)-5-methyl-4-[(4-methylthiophenyl)methyl]pyrazole,3-(6-O-ethoxycarbonyl-β-D-glucopyranosyloxy)-1-isopropyl-5-methyl-4-[(4-methyl-thiophenyl)methyl]pyrazole,3-(6-O-isopropoxycarbonyl-β-D-glucopyranosyloxy)-1-isopropyl-5-methyl-4-[(4-methyl-thiophenyl)methyl]pyrazole,3-(6-O-isobutoxycarbonyl-β-D-glucopyranosyloxy)-1-isopropyl-5-methyl-4-[(4-methyl-thiophenyl)methyl]pyrazole,3-(4-ethylbenzyl)-2-(β-D-gluco-pyranosyloxy)-4,6-dimethylpyridine,2-(β-D-glucopyranosyl-oxy)-3-(4-methoxybenzyl)-4,6-dimethylpyridine,2-(β-D-glucopyranosyloxy)-3-(4-(2-hydroxyethyl)benzyl)-4,6-dimethylpyridineand2-(β-D-glucopyranosyloxy)-6-methoxy-3-(4-methoxybenzyl)-4-methylpyridine

For example, the above compounds can be prepared according to methoddescribed in the above Patent References 1 to 1.9 or an analogous methodthereof.

In the present invention, the term “disease associated with abnormalaccumulation of liver lipids” means a disease wherein the lipidsincluding triglyceride accumulate abnormally in liver, a disease whereinthe ratio of the amount of lipids to healthy cells of the liver and theliver weight increase abnormally, and the size of the liver increasesabnormally. A progressive type wherein the accumulative amount of lipidsfurther increases is also included. Moreover, a disease that shifts toother diseases because of the accumulation of lipids, and a disease withinflammation are also included. Concretely besides common fatty liver,non-alcholic fatty liver disease (NAFL), non-alcholic steatohepatitis(NASH), hypernutritive fatty liver, alcholic fatty liver disease, toxicfatty liver, diabetic fatty liver, acute fatty liver of pregnancy andthe like can be illustrated.

The inhibitory effect on progression of the disease associated withabnormal accumulation of liver lipids can be confirmed by, for example,the examination that uses the KKA^(y) mouse bearing the fatty liver. Thepresent inventors confirmed that when 2-(4-methoxybenzyl)phenyl6-O-ethoxycarbonyl-b-D-glucopyranoside of a SGLT2 inhibitor was orallyadministered to rat, the symptom that the lipid accumulative amount inrat liver increases is inhibited significantly in comparison with thecase where the present compound is not administered. The above-mentionedresult proves that a pharmaceutical composition comprising as an activeingredient a SGLT2 inhibitor is extremely useful as an agent for theinhibition of progression of a disease associated with abnormalaccumulation of liver lipids.

In the present invention, it is possible to use the SGLT2 inhibitor ofthe active ingredient optionally in combination with one or more otherdrugs used for the fatty liver. For example, polyenphosphatidyl cholinepreparation, daisaikoto and the like can be illustrated as other drugsthat can be used in combination. In addition, as far as the purpose ofthe present invention can be achieved, the SGLT2 inhibitor can be usedin combination with a drug other than the above-mentioned drugs. In thecase, metformin, troglitazone, pioglitazone hydrochloride, bezafibrate,voglibose and the like are illustrated as examples of the other drugs.

In the case of uses of the SGLT2 inhibitor in combination with the aboveone or more other drugs, either dosage form of simultaneousadministration as a single preparation or separated preparations in wayof the same or different administration route, and administration atdifferent dosage intervals as separated preparations in way of the sameor different administration route can be adopted.

The pharmaceutical compositions of the present invention can be preparedby suitably admixing with or by diluting and dissolving with anappropriate pharmaceutical additive pharmaceutically used depending onthe compositions or the dosage form such as excipients, disintegrators,binders, lubricants, diluents, buffers, isotonicities, antiseptics,moistening agents, emulsifiers, dispersing agents, stabilizing agents,dissolving aids and the like, by formulating the mixture in accordancewith conventional methods in dosage forms such as powders, granules,fine granules, dry syrups, tablets, capsules, solutions, injections,ointments, suppositories, poultices and the like, which can be orally orparenterally administered. The pharmaceutical compositions of thepresent invention also include a sustained release formulation includinggastrointestinal mucoadhesive formulation (see, for example,International publications Nos. WO99/10010 and WO99/26606, and Japanesepatent publication No. 2001-2567).

The dosage of a SGLT2 inhibitor in a pharmaceutical composition of thepresent invention is appropriately decided depending on the age, sex,body weight and degree of symptoms and treatment of each patient or thelike, which is approximately within the range of from 0.1 to 1,000 mgper day per adult human in the case of oral administration andapproximately within the range of from 0.0.1 to 300 mg per day per adulthuman in the case of parenteral administration. The daily dose can bedivided into one to several doses per day and administered suitably.Also, in case of the uses of the drug(s) in combination with the otherdrug(s) other than SGLT2 inhibitors, the dosage of the SGLT2 inhibitorcan be decreased depending on the dosage of the other drug(s) other thanSGLT2 inhibitors.

EFFECT OF THE INVENTION

As mentioned above, the pharmaceutical compositions of the presentinvention which comprises as an active ingredient a SGLT2 inhibitor havean effect of the inhibition of progression of the disease associatedwith abnormal accumulation of liver lipids, and are highly suitable asan agent for the inhibition of progression of the disease associatedwith abnormal accumulation of liver lipids. Thence, the presentinvention can provide excellent pharmaceutical compositions that caninhibit the progression of the disease associated with abnormalaccumulation of liver lipids by using a SGLT2 inhibitor withoutcompelling patients the conventional dietary restriction by impossiblediet therapy and the exercise therapy difficult to continue.

BEST MODE TO PRACTICE THE INVENTION

The present invention is further illustrated in more detail by way ofthe following Example. However, the present invention is not limitedthereto.

Example 1 Test to Confirm Inhibitory Effect on Accumulation of LiverLipids

Using KKA^(y) mice (KKAy/Ta Jcl, CLEA Japan, Inc.) as experimentalanimals, inhibitory effects on accumulation of lipids in liver based onSGLT2 inhibitory effects were evaluated. KKA^(y) mice bearing fattyliver were prepared as follows.

Female 10-week-old KKA^(y) mice were bred preparatorily for 4 weeks.During preparatory breeding until 4 days before grouping, the mice werefed on a pellet CE-2 diet for laboratory animal (CLEA Japan, Inc.) underfree feeding. From 4 days before grouping, the food was changed to apowdered CE-2 diet for laboratory animal (CLEA Japan, Inc.). At the ageof 14 weeks, body weight, blood glucose level and plasma alanineaminotransferase level (ALT) were measured for grouping. The mice weregrouped (5 animals in each group) so that in any of these threelaboratory values no significant difference was observed between the twogroups. In the second group, the mice were fed on a powdered CE-2 dietfor laboratory animal (CLEA Japan, Inc.) containing 1000 ppm of2-(4-methoxybenzyl) phenyl 6-O-ethoxycarbonyl-β-D-glucopyranoside(hereinafter referred to as Compound A) as a SGLT2 inhibitor for 11days, and then triglyceride contents in liver were measured. The resultsof the measurement were shown in Table 1. As, a consequence, it wasdemonstrated that lipid accumulation in liver was significantlysuppressed by administration of Compound A to KKA^(y) mice bearing fattyliver, compared to drug-untreated mice. This indicates that SGLT2inhibitors exhibit inhibitory effects on the progression of diseasesassociated with by abnormal lipid accumulation in liver.

Method of measurement of liver triglyceride content was described asfollows.

1) Ice-cold saline (Otsuka Pharmaceutical Co., Ltd.) was added to liverin the proportion of 4 mL of ice-cold saline to 1 g of the liver, andthen a homogenized suspension was prepared in a pestle homogenizer.

2) To 100 μL of the suspension 1), 800 μL of Folch reagent(chloroform:methanol=2:1) was added and mixed vigorously, and totallipids was extracted.

3) The mixture 2) was centrifuged (3000 rpm, for 1 min, at roomtemperature) using a cooled centrifuge (KUBOTA8900, KUBOTA Corporation).

4) The lower layer after centrifugation in 3) was collected andtransferred to another containers and that is referred to as Solution(A).

5) To the upper layer after centrifugation in 3) 150 μUL of Folchreagent was added and mixed vigorously, and centrifugation by theoperation identical to that in 3) was performed. The lower layer wasadded to the Solution (A) described above.

6) To the Solution (A) obtained in 5), 250 μL of saline was added andmixed vigorously, and centrifugation by the operation identical to thatin 3) was performed again.

7) The upper layer after centrifugation in 6) was removed by suction,and the solvent of the lower layer was removed under a nitrogen flow.

8) The residue 7) was dissolved by adding of 300 μL of Folch reagent.

9) From the solution 8), 10 μL of that was transferred to a RIAbeadstube (Dainabot Co., Ltd.), and the solvent was removed under a nitrogenflow.

10) Triglyceride was measured in a reaction in which 1.5 mL of acoloring reagent of Triglyceride E-test Wako (Wako Pure ChemicalIndustries, Ltd.) was added to the residue 9).

11) The liver triglyceride content per gram was calculated from theresults obtained in 10). The data were expressed as the mean ±standarderror of the mean. TABLE 1 Liver triglyceride content Group Matter (mg/gliver) The 1^(st) group Drug-untreated 43.0 ± 5.7  The 2^(nd) groupDrug-treated 25.4 ± 3.6* (Compound A)The symbol “*” in Table 1 means that there is a statisticallysignificant difference (significance level is 5% or less) from the1^(st) group.

INDUSTRIAL APPLICABILITY

The pharmaceutical compositions of the present invention which comprisesas an active ingredient a SGLT2 inhibitor have an effect of theinhibition of progression of the disease associated with abnormalaccumulation of liver lipids, and are useful as an agent for theinhibition progression of a disease associated with abnormalaccumulation of liver lipids.

1. A pharmaceutical composition for the inhibition of progression of a disease associated with abnormal accumulation of liver lipids, which comprises as an active ingredient a sodium/glucose co-transporter 2 inhibitor.
 2. A pharmaceutical composition for the inhibition of progression as claimed in claim 1 wherein the sodium/glucose co-transporter 2 inhibitor is 2-(4-methoxybenzyl)phenyl β-D-glucopyranoside or a pharmaceutically acceptable salt thereof, or a prodrug thereof.
 3. A pharmaceutical composition as claimed in claim 1 which is used in combination with one or more selected from a group consisting of metformin, troglitazone, pioglitazone hydrochloride, bezafibrate and voglibose.
 4. A pharmaceutical composition as claimed in claim 2 which is used in combination with one or more selected from a group consisting of metformin, troglitazone, pioglitazone hydrochloride, bezafibrate and voglibose.
 1. A pharmaceutical composition for the inhibition of progression of a disease associated with abnormal accumulation of liver lipids, which comprises as an active ingredient a sodium/glucose co-transporter 2 inhibitor.
 2. A pharmaceutical composition for the inhibition of progression as claimed in claim 1 wherein the sodium/glucose co-transporter 2 inhibitor is 2-(4-methoxybenzyl)phenyl β-D-glucopyranoside or a pharmaceutically acceptable salt thereof, or a prodrug thereof.
 3. A pharmaceutical composition as claimed in claim 1 or 2 which is used in combination with one or more selected from a group consisting of metformin, troglitazone, pioglitazone hydrochloride, bezafibrate and voglibose. 